The 2024 revisions to the McDonald criteria for Multiple Sclerosis were recently presented at the 2024 ECTRIMS conference in Copenhagen by professor Xavier Montalban and include several important changes. THe goal of the changes is to refine the balance between sensitivity and specificity of the MS diagnosis. The goal is to be able to diagnose MS as early as possible, but also ruling out other conditions. In the end, MS is still a diagnosis of exclusion that can only be made when other conditions are ruled out. Detection of white matter lesions in the brain and/or spinal cord is essential for the dagnosis, as an abnormal MRI is required for the diagnosis.
New in the 2024 criteria are:
- The introduction of the optic nerve as a fifth topographical location.
- The number of topographic locations for dissemination of space.
- The criterium "dissemination in time" is not always needed.
- The central vein sign can now be used as a diagnostic criterium.
- Paramagnetic rim lesions can now be used as diagnostic lesions.
- MS diagnosis can be made in previous radiologically isolated syndrome.
0:00 - Introduction
3:01 - Case: DIS & DIT
5:41 - Dissemination in space (DIS)
6:38 - Dissemination in time (DIT)
8:27 - Summary: DIS, DIT & 2024 revisions
10:37 - Case: Optic neuritis as a fifth CNS-topography
14:47 - Case: 4 CNS-topographies = MS
16:24 - The Central Vein Sign
19:20 - Paramagnetic Rim Lesions
23:07 - CVS & PMRs for the diagnosis of MS?
24:31 - Case: one topography + CVS/PMR + DIT/CSF
26:24 - Primary Progressive Multple Sclerosis
27:28 - Radiologically isolated syndrome (RIS)
31:04 - Age & comorbidities, when is it MS?
32:35 - Summary
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